Revisiting the Navajo way: lessons for contemporary healing

Embedding DBT Skills Training Within a Transactional-Ecological Framework to Reduce Suicidality in a Navajo Adolescent Female

American Indian/Alaska Native (AI/AN) youth have higher rates of suicidality than any other ethnic or cultural group in the United States. Dialectical behavior therapy (DBT) is an evidence-based treatment that has been found to reduce suicidality in adolescents, but there is little literature speaking to its efficacy with the AI/AN population. The transactional-ecological model of suicidality helps identify protective factors that can be bolstered at the individual, familial, community, and spiritual levels to reduce suicidality and suicidal contagion in AI/AN youth. The current study examines a case where DBT was culturally adapted and embedded within a transactional-ecological framework to treat a 14-year-old Navajo female with Major Depressive Disorder with psychotic features who presented to a psychiatric inpatient facility following a suicide attempt. The patient’s wish to die was motivated by her belief that her death could lead to positive changes in an extended family system plagued by historical trauma, alcoholism, suicide, and domestic violence. Ongoing assessment was conducted using the Suicide Status Form (SSF), Suicide Probability Scale (SPS), Reasons for Living Scale for Adolescents (RFL-A), and the DBT diary card. Navajo healing traditions were used in conjunction with DBT skills training and enhancement of ecological protective factors. Initial reduction in depression and suicidality was complicated by an increase in homicidal ideation. A comprehensive psychiatric evaluation was completed, and treatment was modified through medication changes, increased mindfulness practice, bolstering support systems, and engagement in a Navajo healing ceremony. Implications for clinicians treating suicidality in Navajo youth are discussed.

Researching Prescription Drug Misuse among First Nations in Canada: Starting from a Health Promotion Framework

The intentional misuse of psychotropic drugs is recognized as a significant public health concern in Canada, although there is a lack of empirical research detailing this. Even less research has been documented on the misuse of prescription drugs among First Nations in Canada. In the past, Western biomedical and individual-based approaches to researching Indigenous health have been applied, whereas First Nations' understandings of health are founded on a holistic view of wellbeing. Recognition of this disjuncture, alongside the protective influence of First Nations traditional culture, is foundational to establishing an empirical understanding of and comprehensive response to prescription drug misuse. We propose health promotion as a framework from which to begin to explore this. Our work with a health promotion framework has conveyed its potential to support the consideration of Western and Indigenous worldviews together in an 'ethical space', with illustrations provided. Health promotion also allots for the consideration of Canada's colonial history of knowledge production in public health and supports First Nations' self-determination. Based on this, we recommend three immediate ways in which a health promotion framework can advance research on prescription drug misuse among First Nations in Canada.

Concept analysis of Diné Hózhó: a Diné wellness philosophy

American Indian Alaska Native people of the United States face challenges in attaining physical, mental, spiritual, and environmental health. This article presents a concept analysis of Diné Hózhó, a complex and misunderstood wellness concept the Diné (Navajo) strive to attain. Findings from a literature review are presented to explore anthropological definitions and uses of the concept Hózhó. The method of concept analysis of Walker and Avant is utilized, model cases are presented. Recommendations for application in nursing practice are presented.